摘要
体外循环术后血管麻痹综合征(VS)的发生越来越受到关注,VS的显著特点是持续、顽固的体循环低血压,正常或升高的心排血量及全身血管阻力降低,致升压药物的使用剂量亦明显增加,并可产生不同程度的抵抗。在不同的机构和专业领域,VS的发病率、诊疗及预后亦存在巨大差异。导致VS发生的风险因素有高龄、输血、体外循环、器官移植、创伤和脓毒症,以及特定药物的应用,如血管紧张素转换酶抑制剂、他汀类等;VS的发病机制有:炎性因子和神经介质的释放,诱导一氧化氮的产生过剩,血管加压素受体的下调,使平滑肌丧失收缩功能,导致血管麻痹。目前对VS的治疗包括静脉泵入去甲肾上腺素、血管加压素、亚甲基蓝和高剂量羟钴胺素,以及使用腺苷三磷酸敏感的钾通道阻滞剂,核因子κB抑制剂,靛蓝二磺酸钠。
Vasoplegic syndrome （VS） is getting increasing attention as a series of perioperative complications after car- diopulmonary bypass, characterized by continuous and significant arterial hypotension, normal or high cardiac output, low systemic vascular resistance,increased requirements for vasopressors, and the resistance of vasoactive drugs. The incidence, diagnosis, treatment and prognosis of VS are tremendously varied in different fields and institutions. However, the risk fac- tors that cause VS are age, blood transfusion, extracorporeal circulation, organ transplantation, trauma and sepsis, and the use of specific medications, such as angiotensin converting enzyme inhibitors, statins and so on; the pathogenesis of VS may have several mechanistic pathways：the release of inflammatory factors and neurotransmitters,the production of excess nitric oxide, down-regulated vasopressin receptor, which cause loss of systolic function of the smooth muscle, leading to vascular paralysis. Current treatments for VS include intravenous norepinephrine, vasopressin, methylene blue and high doses of hydroxycobalamin, the use of adenosine triphosphate-sensitive potassium channel blockers, nuclear factor-κB inhibitors , and indigo sodium disulfonate.
作者
卢圣勋
邢亚闯
范义兵
张娜
罗俊辉
LU Shengxun XING Yachuang FAN Yibing ZHANG Na LUO Junhui.(Department of Cardiovascular Surgery, PLA 150th Central Hospital, Luoyang 471031, China)
出处
《医学综述》
2017年第18期3690-3694,共5页
Medical Recapitulate
关键词
血管麻痹综合征
体外循环
全身炎症反应综合征
Vasoplegic syndrome
Cardiopulmonary bypass
Systemic inflammatory response syndrome
